Authorization Specialist

General Summary Of Duties Responsible for obtaining prior authorization for patient services which includes verifying insurance data and submission of authorizations and pre-certifications for all clinic services to insurance companies. Communicate with clinical staff and insurance companies coding, and billing information. Obtains insurance authorizations and pre-certifications for all clinic services in which it is required, based on insurance company guidelines. Communicates with clinical staff regarding restrictions or unique requirements. Maintains current working knowledge of authorization requirements for all payers, and of state & federal regulatory guidelines. Demonstrates an understanding of patient confidentiality to protect the patient and clinic. Complies with clinic policies and procedures regarding regular work attendance. Assist staff with questions related to authorizations. Investigates all authorization denials and communicates with clinic staff to obtain supporting documentation. Notification to appropriate clinic staff of any services requested and/or referred that are not authorized by insurance. Maintains timely, complete documentation and recordkeeping to ensure accurate continuity of patient care. te any insurance changes or discrepancies with appropriate department. General Summary Of Duties Responsible for obtaining prior authorization for patient services which includes verifying insurance data and submission of authorizations and pre-certifications for all clinic services to insurance companies. Communicate with clinical staff and insurance companies coding, and billing information. Obtains insurance authorizations and pre-certifications for all clinic services in which it is required, based on insurance company guidelines. Communicates with clinical staff regarding restrictions or unique requirements. Maintains current working knowledge of authorization requirements for all payers, and of state & federal regulatory guidelines. Demonstrates an understanding of patient confidentiality to protect the patient and clinic. Complies with clinic policies and procedures regarding regular work attendance. Assist staff with questions related to authorizations. Investigates all authorization denials and communicates with clinic staff to obtain supporting documentation. Notification to appropriate clinic staff of any services requested and/or referred that are not authorized by insurance. Maintains timely, complete documentation and recordkeeping to ensure accurate continuity of patient care. te any insurance changes or discrepancies with appropriate department. Essential Duties Obtains insurance authorizations and pre-certifications for all clinic services in which it is required, based on insurance company guidelines. Communicates with clinical staff regarding restrictions or unique requirements. Maintains current working knowledge of authorization requirements for all payers, and of state & federal regulatory guidelines. Demonstrates an understanding of patient confidentiality to protect the patient and clinic. Complies with clinic policies and procedures regarding regular work attendance. Assist staff with questions related to authorizations. Investigates all authorization denials and communicates with clinic staff to obtain supporting documentation. Notification to appropriate clinic staff of any services requested and/or referred that are not authorized by insurance. Maintains timely, complete documentation and recordkeeping to ensure accurate continuity of patient care. te any insurance changes or discrepancies with appropriate department. Other Duties Investigates changes in insurance requirements or policies through review of websites, manuals, newsletters, and attending meetings. Applies changes as appropriate based on information gathered. Educates co-workers on changes when necessary. Assists patients with payments on accounts either in person on via phone. Work closely with patient to ensure they understand their account and insurance guidelines. Provides back-up phone support to business office. Supports and promotes the mission and strategic vision of the clinic. Ensure an ideal patient experience.

EDUCATION

High School diploma or GED. D. Experience 1-year medical terminology 1-year prior experience in pre-authorizations/precertification and processing of health claims. E. Knowledge, Abilities And Skills Knowledge of basic insurance processing and pre-authorizations. Knowledge of medical terminology and coding. Knowledge of grammar, spelling, and punctuation to type patient information accurately. Knowledge of various insurance types, authorization submission and tracking processes. Ability to work with a high level of attention to detail and accuracy. Ability to read, understand and follow verbal and written instructions. Ability to work independently to investigate and resolve insurance denials in a timely manner. Ability to prioritize work and multitask in a fast-paced environment. Ability to multi-task effectively and make decisions in a fast-paced environment while maintaining a calm and pleasant manner. Skills in using mathematical calculations to review patient accounts. Skills in using customer service principles to work cooperatively with patients in order to resolve questions and discrepancies. operating a computer (keyboarding accuracy, approximately 40 wpm) and office machines. Skills in oral and written communication. F. Requirements No certification is necessary.

G. EQUIPMENT

Computer, printer/copier, multi-line telephone, fax, credit card machine, resources such as insurance manuals and the internet.

H. SUPERVISION

Business Office Supervisor I. Additional Position Requirements The job holder must demonstrate current competencies applicable to the job position. This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve. #J-18808-Ljbffr St. Cloud Orthopedics